All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT.

Behavioral: gaze stability

Vestibular adaptation and substitution exercises were designed originally based on the error signals (retinal slip) that induce changes in gain in the vestibular system and will be performed by the experimental group (GS). Adaptation exercises involve head movement while maintaining focus on a target, which may be stationary or moving. Typical progression of adaptation exercises involve increased velocity of head movement, movement of both target and head, target placed in a distracting visual pattern and maintenance of a challenging posture. Substitution exercises specifically attempt to facilitate use of alternative strategies, rather than teaching the specific strategies. During active eye-head exercise, a large eye movement to a target is made prior to the head moving to face the target, potentially facilitating use of preprogrammed eye movements.

Placebo Comparator: control

standard balance rehabilitation plus placebo eye exercises

Behavioral: standard balance rehabilitation

All subjects will perform balance and gait exercises in addition to the eye movement exercises and will be provided a written HEP consisting of balance and gait exercises designed to improve postural stability and mobility with progressively more challenging tasks. Balance exercises will include maintaining stability in standing with vision and somatosensory cues altered, dynamic weight shifting and performing ankle, hip and step strategies. Gait activities will include negotiating uneven terrains and obstacles, gait with slow head turns focusing on objects, varied speed (speeding up and slowing down), and unpredictable starts and stops. Walking for endurance will be included in the HEP. Each participant will receive a customized balance and gait HEP based on identified impairments and will be progressed according to ability and level of assistance at home as is standard in PT.

Behavioral: Control

The placebo exercises will consist of saccadic eye movements while the head is stationary and will be performed by the control group. These eye movements will be performed against a plain background in order to eliminate retinal slip and, therefore, eliminate the error signal for vestibular adaptation.

Detailed Description:

Dizziness is among the most prevalent complaints for which people seek medical help and the incidence increases with advancing age. Dizziness represents a diagnostic and treatment challenge because it is a subjective sensation, refers to a variety of symptoms (unsteadiness, spinning, sense of motion or lightheadedness), and has many potential contributory factors. Dizziness is often related to vestibular disease which is treated effectively with vestibular exercises. Successful management of dizziness is critical because dizziness is a major risk factor for falls in older adults.

There are parallels between the effects of age-related versus disease-related loss of vestibular function - in complaints of dizziness and increased risk for falls. Our question, then, is whether the same exercises that are beneficial for patients with vestibular pathology are beneficial for older patients with dizziness but normal vestibular function.

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01729039